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"ABSTRAKDuring 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety."

"DETECTION OF VASCULAR ENDOTHELIAL DYSFUNCTION AS ANEARLY ATHEROSCLEROSIS MARKER:Effect of breastfeeding duration on vascular characteristicsand other cardiovascular risk factorsBackground. Atherosclerosis already starts to develop in childhood andadolescence. Breastmilk has been recognized to have some protective effects onthe development of atherosclerosis, but the optimal duration in relation tocardiovascular risk is largely unknown.Objective. To investigate the effect of breastfeeding duration on vascularcharacteristics and other cardiovascular risk factor levels in adolescence.Methods. We conducted a retrospective cohort study on adolescents aged 15-18years old. Breastfeeding duration was inquired using a questionnaire filled byparents and categorised into 0-<2, 2-<4, 4-<6, 6-<12, and >12 months. Outcomesassessed were flow mediated dilation (FMD), carotid intima media thickness(CIMT), anthropometrics, lipid/glucose level, high-sensitive C-reactive protein(hs-CRP), and vascular cell adhesion molecule (VCAM). Analysis was done usingANOVA and MANOVA general linear model with cardiovascular risk factors asthe dependent variables and breastfeeding duration as the independent variablewith further adjustment for confounders.Results. We enrolled 285 subjects. Breastfeeding duration of 4-<6 months wasassociated with thinner cIMT and the effect was more prominent after adjustmentfor gender and postnatal tobacco exposure (mean difference =24.28 micrometer, P=0.045). Both in univariable and multivariable analyses, breastfeeding duration of4-<6 months showed a statistically significant association with waist-to-hip ratio(0.87 vs. 0.81, P<0,001), but not with FMD, lipid profile, and other cardiovascularbiomarkers.Conclusions. Breastfeeding duration of 4-<6 months is associated with thinnerIMT and thus has a protective effect on the development of cardiovasculardisease. However the association with FMD and other cardiovascular risk factorlevels in adolescents is less clear

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DETEKSI DISFUNGSI ENDOTEL VASKULAR PADA REMAJA

SEBAGAI PENANDA AWAL ATEROSKLEROSIS:

Pengaruh lama pemberian air susu ibu pada masa bayi terhadap fungsi dan

struktur vaskular serta beberapa faktor risiko kardiovaskular lainnya

Latar belakang. Proses terjadinya aterosklerosis telah dimulai sejak masa anak.

Air susu ibu (ASI) diduga memiliki efek protektif terhadap perkembangan

aterosklerosis, tetapi lama pemberian ASI yang optimal terkait risiko

kardiovaskular belum diketahui secara pasti.

Tujuan. Mengetahui pengaruh lama pemberian ASI terhadap karakteristik

pembuluh darah dan faktor risiko kardiovaskular pada masa remaja.

Metodologi. Studi kohort retrospektif terhadap remaja usia 15-18 tahun. Data

mengenai lama pemberian ASI diperoleh dari kuesioner yang diisi oleh orangtua

dan dikelompokkan menjadi 0-<2, 2-<4, 4-<6, 6-<12, dan >12 bulan. Luaran

penelitian adalah flow-mediated dilation (FMD), ketebalan tunika intima media

(KTIM), profil lipid/glukosa darah, high-sensitive C-reactive protein (hs-CRP),

vascular cell adhesion molecule (VCAM) dan ukuran antropometri. Analisis

statistik dilakukan dengan uji ANOVA dilanjutkan dengan MANOVA general

linear model dengan faktor risiko kardiovaskular sebagai variabel dependen dan

lama pemberian ASI sebagai variabel independen dengan memperhitungkan

variabel perancu.

Hasil. 285 subjek diikutsertakan dalam penelitian. Lama menyusui 4-<6 bulan

berhubungan dengan KTIM arteri karotis yang lebih tipis baik analisis bivariat

maupun multivariat (beda rerata 24,28 mikrometer, p=0,045). Rasio lingkar

pinggang terhadap panggul sedikit lebih besar pada remaja dengan lama

pemberian ASI 4<6 bulan dibandingkan kelompok lain (0,87 vs. 0,81, p<0,001).

Lama pemberian ASI tidak menunjukkan hubungan yang bermakna dengan FMD

dan faktor risiko kardiovaskular lainnya.

Kesimpulan. Lama pemberian ASI 4-<6 bulan berhubungan dengan KTIM yang

lebih tipis sehingga mempunyai efek protektif terhadap terjadinya penyakit

kardiovaskular. Namun tidak ditemukan hubungan yang nyata antara lama

pemberian ASI dengan FMD dan faktor risiko kardiovaskular lainnya."

"During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents. The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

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Dalam kurun waktu 11 tahun antara 1Januari 2005 sampai 31 Desember 20015 sebanyak 18 kasus PDA

pada anak remaja dan dewasa dilakukan penutupan PDA dengan alat Amplatzer Duct Occluder (ADO). Terdapat 9 kasus anak remaja yang berumur antara 14-18 tahun dan 9 orang dewasa yang berumur di atas 18 tahun dengan umur yang tertua 46 tahun. Sebelum pelaksanaan tindakan, dilakukan pemeriksaan klinis, EKG dan foto toraks serta ekokardiografi transtorakal untuk konfirmasi diagnostik PDA. Prosedur implantasi ADO dilakukan dengan anastesi umum pada remaja dan anestesi lokal dan sedasi pada pasien dewasa. Ukuran diameter PDA berkisar antara 1,6 mm-11,1 mm. Berdasarkan klasifikasi Kritchenko terdiri dari 15 PDA tipe A1 dan 3 kasus tipe A2. Flow rati oantara sirkulasi pulmonal dan sirkulasi sistemik berkisar antara 1,1?5,9. Waktu pelaksanaan prosedur berkisar antara 60-189 menit dengan waktu florsokopi antara 7,1-77,3 menit. Tekanan rata-rata pada arteri pulmonalis berkisar antara 22-63 mmHg dengan tekanan tertinggi sebesar 63 mmHg terdapat pada 2 kasus (no 12 dan 13). Segera setelah prosedur tindakan menujukkan penutupan total pada 14 kasus dan pada4 kasus terdapat pirau residual minimal pada gambaran angiografi yang kemungkinan disebabkan kebocoron sementara melalui sela-sela device. Dalam 24 jam pertama setelah tindakan ditemukan penutupan total pada semua kasus (100%) dan hasil tersebut ditemukan sampai 1 bulan dan 6 bulan setelah tindakan. Selama kurun waktu tersebut tidak ditemukan sisa pirau (residual shunts) dan komplikasi berarti lainnya seperti embolisasi device atau rekanalisasi pada duktus. Hasil studi seri kasus ini ini menunjukkan bahwa penutupan PDA dengan prosedur transkateter menggunakan ADO pada pasien remaja dan dewasa dalam jangka pendek sangat baik dan efektif serta tidak ada komplikasi yang berarti. Namundemikian masih diperlukan pemantauan jangka panjang untuk menilai efektivitas dan keamanan prosedur ini."